Billing for Services Related to Voluntary Uses of Advanced Beneficiary Notices of Noncoverage (ABNs)
Date Issued: 02-19-2010
Implementation Date: 04-09-2010
Effective Date: 04-01-2010
Source: CMS - Transmittal
Source#: CR6563
Category: Bill/Pmt SNF Inpatient
CBSI Contact: Missy Tieken
 
HCPCS level 2 modifiers have been updated in order to distinguish between voluntary and required uses of liability notices. Modifier ?GA has been redefined to mean ?Waiver of Liability Statement Issued, as Required by Payer Policy.? This modifier is only to be used to report when a required ABN was issued for a service. As stated in previous instructions, the GA modifier should not be reported in association with any other liabilityrelated modifier and should continue to be submitted with covered charges. However, Medicare systems will now deny these claims as a beneficiary liability (rather than subjecting them to possible medical review), and the beneficiary will have the right to appeal this determination. A new modifier, GX, has been created with the definition ?Notice of Liability Issued, Voluntary Under Payer Policy.? This modifier is to be used to report when a voluntary ABN was issued for a service. Providers may use the ?GX modifier to provide beneficiaries with voluntary notice of liability regarding services excluded from Medicare coverage by statute. In these cases, the ?GX modifier may be reported on the same line as certain other liabilityrelated modifiers. The ?GX modifier must be submitted with noncovered charges only and will be denied by the Medicare contractor as a beneficiary liability. These changes are informational only for Medicare Part B and Durable Medical Equipment Medicare Administrative Contractors and do not impact claims processing for the MultiCarrier System and the ViPS (Viable Information Processing System) Medicare System.

http://www.cms.gov/transmittals/downloads/R1921CP.pdf


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